Promoting Resilience After Stroke in Dyads (ReStoreD): A Supplemental Analysis

OBJECTIVE

To examine preliminary effects of ReStoreD (Resilience after Stroke in Dyads) on resilience in couples coping with stroke-related challenges.

DESIGN

Supplemental analysis of prospective pilot trial with pre-/post-assessments and 3-month follow-up.

SETTING

Community.

PARTICIPANTS

Thirty-four cohabitating stroke-care partner dyads (N=34); at least 3 months post-stroke.

INTERVENTIONS

8-week self-administered dyadic intervention (ReStoreD) consisting of activities completed individually and as a couple.

MAIN OUTCOME MEASURES

10-item Connor-Davidson Resilience Scale.

RESULTS

Care partner baseline resilience scores were significantly higher than persons with stroke scores. Repeated-measures analysis of variance suggest significant pre-post improvement in resilience for persons with stroke (mean difference [I - J]=-2.42, SE=.91, P=.04, 95% CI [-4.75, -0.08]) with a large effect size (η2=.34), which was maintained at 3-month follow-up. Care partners showed no significant change over time.

CONCLUSIONS

This study provides preliminary evidence that ReStoreD improves resilience in persons with stroke. More research is needed to address resilience in care partners. These findings represent a promising first step to address the mental health needs in this population.

Feasibility and acceptability of the Resilient Living program among persons with stroke or brain tumor and their family caregivers

BACKGROUND

Practice guidelines and research results emphasize the need for dyadic interventions targeting psychosocial outcomes such as depression, anxiety, social function, physical function, and health-related quality of life. Resilience interventions have been proposed as one strategy to influence these outcomes.

OBJECTIVE

The objective of this observational pilot study was to determine the feasibility and acceptability of the Resilient Living program among persons with stroke or brain tumor (BT) admitted for comprehensive acute inpatient rehabilitation and/or their family caregivers. A secondary aim was to gather preliminary data to assess the effects of the program on quality of life, stress, anxiety, physical function, sleep disturbance, fatigue, resilience, dyadic coping, and caregiver role overload.

METHODS

The Resilient Living program is a psychosocial intervention with a focus on building resilience skills. Feasibility and acceptability outcomes were assessed at the end of the study. Quantitative outcome measures were collected at baseline, 12 weeks, and 6 months post the intervention.

RESULTS

Eight patients and eight caregivers completed the study. The intervention was feasible with this population. Participants found the intervention useful and appreciated the flexibility of an online program; however, finding time to engage in it was challenging. Recruitment of eligible patients with acquired brain disorders and their caregivers as a dyad was challenging.

CONCLUSION

The study confirms prior research suggesting that interventions targeting resilience are feasible, but larger studies with more rigorous methods are needed to appreciate the influence of resilience interventions in persons with brain disorders and their caregivers. Further research is needed to identify the characteristics of those most likely to benefit from resilience interventions and the optimal timing of such interventions.

A Narrative Review on the Non-Pharmacologic Interventions in Post-Stroke Depression

Stroke is a major cause of death and disability globally. Post-stroke depression (PSD) is a major driver for poor recovery and poor quality of life with extra burden for the patient and the caregiver. We have previously shown the inflammatory basis of PSD with associated bioenergetic failure, disruption of the blood-brain barrier, cell death, and persistent maladapted inflammation, making the PSD a norm rather than the exception, highlighting the unmet need for therapeutic intervention in PSD across the recovery trajectory. In this era, various interventions are focused on pharmacotherapy; however, non-pill-based medication should also be explored as post-stroke patients are likely to suffer from the adverse effects of polypharmacy. This narrated review explores the status of non-pharmacological interventions in managing PSD. We performed a PubMed search using pre-specified keywords looking at various non-pharmacologic approaches for the management of PSD. Worldwide, approaches such as non-invasive brain stimulation, behavioral and psychosocial therapy, as well as exercise, acupuncture, music, literature, and art therapies are available as monotherapy or adjunctive treatment for PSD. While current literature shows convincing results on the benefits of non-pharmacologic interventions, more robust studies are necessary to determine its utility in PSD.

Intimate Relationships and Stroke: Piloting a Dyadic Intervention to Improve Depression

Stroke affects not only the survivor but also their romantic partner. Post-stroke depression is common in both partners and can have significant negative consequences, yet few effective interventions are available. The purpose of this study was to pilot test a novel 8-week remotely administered dyadic intervention (ReStoreD) designed to help couples better cope with stroke-related changes and reduce depressive symptoms. Thirty-four cohabitating survivor–partner dyads at least 3 months post-stroke and reporting some changes in mood were enrolled. Depressive symptoms were assessed pre- and post-intervention and at 3-month follow-up. Repeated measures analysis of variance was used to assess the effects of ReStoreD over time on depressive symptoms in stroke survivors and their partners. Twenty-six dyads completed the study. Although statistical significance was not reached, there was a large effect size for improvements in depressive symptoms for stroke survivors. There was no significant improvement for partners, and the effect size was minimal. Those with more significant depressive symptoms at baseline were more likely to benefit from the intervention. This pilot study established proof-of-concept by demonstrating that depressive symptoms can be lessened in stroke survivors and partners with more severe depressive symptoms. Future research will establish the efficacy of the intervention in a fully powered study.

A systematic review of psychosocial interventions for Latinx and American Indian patient-family caregiver dyads coping with chronic health conditions

Latinx and American Indians experience high rates of chronic health conditions. Family members play a significant role as informal caregivers for loved ones with chronic conditions and both patients and family caregivers report poor psychosocial outcomes. This systematic review synthesizes published studies about psychosocial interventions for Latinx and American Indian care dyads to determine: (i) the benefits of these interventions; (ii) their distinguishing features or adaptations, and; (iii) recommendations for future intervention development. Out of 366 records identified, seven studies met inclusion criteria. Interventions demonstrated benefits to outcomes such as disease knowledge, caregiver self-efficacy and burden, patient and caregiver well-being, symptom distress, anxiety and depression, and dyadic communication. Distinguishing features included tailoring to cultural values, beliefs, and delivery preferences, participants' level of acculturation, and population-specific issues such as migratory stressors and support networks. Based upon this review, six recommendations for future intervention development are put forth.

Comparison of Psychological Health Problems between Families Living with Stroke Survivors and the General Population in the Community

This study aimed to identify and assess the differences in psychological health problems between families living with stroke survivors (FwSS) and the general population without stroke families (GwoSF). A total of 4,514 cases of FwSS were selected for analysis from the 2013 Korea Community Health Survey. In order to determine control groups in GwoSF, propensity scores were generated based on the sociodemographic characteristics of age, gender, residential region, marital status, educational level, monthly household income, and employment status. Each FwSS was matched to 3 controls of GwoSF (13,542 controls) using a greedy matching algorithm with 8 to 1 digit matching. After propensity score-matching, the proportion of usual stress (30.2% vs 24.6%), depressive mood (7.1% vs 6.1%), and suicidal ideation (13.0% vs 11.1%) in FwSS were all significantly higher than those in GwoSF (Ps<0.05). Compared to GwoSF, the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for psychological health problems in FwSS were calculated using multiple logistic regression analysis. The aORs for usual stress (aOR 1.32, 95% CI 1.21–1.42), depressive mood (aOR 1.14, 95% CI 0.99–1.31; borderline significance), and suicidal ideation (aOR 1.17, 95% CI 1.05–1.30) were significantly higher among FwSS than GwoSF. Moreover, the psychological health problems of FwSS were more evident in females than in males. This study shows that FwSS have poorer psychological health outcomes than GwoSF with similar sociodemographic characteristics. Community-based strategies and family support programs, especially for female family members of stroke survivors, are essential to improve the psychological health of stroke families.

Dyadic appraisals, dyadic coping, and mental health among couples coping with stroke: A longitudinal study protocol

AIM

The aim of this study is to describe a longitudinal research protocol for exploring the relationship of dyadic appraisal, dyadic coping (DC), and dyadic mental health among stroke survivors and their spouses and its action path.

BACKGROUND

Stroke can be considered as a dyad phenomenon which affects the mental health of both the survivors and their spouse caregivers. Studies based on dyadic theories are needed to examine the roles of dyadic appraisal and DC on the mental health of stroke dyads.

DESIGN

Longitudinal study.

METHODS

Stroke survivors and their spouse caregivers will be recruited from hospital, when the survivors are stable and about to discharge. Follow-up assessments will take place in 3, 6, 9, and 12 months after participants discharge. The structural equation modelling will be used for statistic analysing.

DISCUSSION

Our study seeks to expand the theory of Developmental-Contextual Model to examine the association among variables including dyadic appraisal, DC, and mental health for the couples coping with stroke.

The Perceived Marital Intimacy of Spouses Directly Influences the Rehabilitation Motivation of Hospitalized Stroke Survivors

Spousal support is likely to influence the rehabilitation motivation of stroke survivors who require long-term rehabilitation. This study was conducted to examine the reciprocal effects of the depressive symptoms and marital intimacy of stroke survivors and their spouses, and identify the factors that influence the rehabilitation motivation of stroke survivors. For this cross-sectional descriptive study, 72 stroke survivor-spouse couples were recruited from four rehabilitation hospitals in South Korea in 2017. The collected data were analyzed using path analyses with SPSS 20.0 and the R package. There were significant differences in the actor effects of stroke survivors' and spouses' depressive symptoms on the marital intimacy of the survivors and their spouses. The perceived marital intimacy of spouses was significantly associated with the rehabilitation motivation of stroke survivors. In order to enhance their rehabilitation motivation, it is necessary to periodically assess the depressive symptoms and perceived marital intimacy of their spouses.

Dyadic approach to supervised community rehabilitation participation in an Asian setting post-stroke: exploring the role of caregiver and patient characteristics in a prospective cohort study

OBJECTIVE

To study the association of caregiver factors and stroke survivor factors with supervised community rehabilitation (SCR) participation over the first 3 months and subsequent 3 to 12 months post-stroke in an Asian setting.

DESIGN

Prospective cohort study.

SETTING

Community setting.

PARTICIPANTS

We recruited stroke survivors and their caregivers into our yearlong cohort. Caregiver and stroke survivor variables were collected over 3-monthly intervals. We performed logistic regression with the outcome variable being SCR participation post-stroke.

OUTCOME MEASURES

SCR participation over the first 3 months and subsequent 3 to 12 months post-stroke RESULTS: 251 stroke survivor-caregiver dyads were available for the current analysis. The mean age of caregivers was 50.1 years, with the majority being female, married and co-residing with the stroke survivor. There were 61%, 28%, 4% and 7% of spousal, adult-child, sibling and other caregivers. The odds of SCR participation decreased by about 15% for every unit increase in caregiver-reported stroke survivor's disruptive behaviour score (OR: 0.845; 95% CI: 0.769 to 0.929). For every 1-unit increase in the caregiver's positive management strategy score, the odds of using SCR service increased by about 4% (OR: 1.039; 95% CI: 1.011 to 1.068).

CONCLUSION

We established that SCR participation is jointly determined by both caregiver and stroke survivor factors, with factors varying over the early and late post-stroke period. Our results support the adoption of a dyadic or more inclusive approach for studying the utilisation of community rehabilitation services, giving due consideration to both the stroke survivors and their caregivers. Adopting a stroke survivor-caregiver dyadic approach in practice settings should include promotion of positive care management strategies, comprehensive caregiving training including both physical and behavioural dimensions, active engagement of caregivers in rehabilitation journey and conducting regular caregiver needs assessments in the community.

Development and validation of a quality of relationship intervention for stroke survivor-family caregiver dyads

Background: The relationship between stroke survivors and family caregivers is critical for the well-being of both dyad members. Currently, there are few interventions targeted at dyads and focused on strengthening the relationship between survivors and family caregivers.Objectives: This study reports on the development of a customizable, strengths-based, relationship-focused intervention driven by the real-world experience and advice of stroke dyads. It also describes the "tips" that survivors and family caregivers offered for dealing with relationship challenges after stroke.Methods: Content of the intervention, including relationship tips, was derived from semi-structured interviews with N= 19 stroke dyads. A modified Delphi process with a national panel of 10 subject matter experts was used to evaluate and refine the content of the intervention and the associated screening tool.Results: Seventeen domains of relationship challenges and tips were identified. Consensus was reached among experts that the intervention content was relevant to the goal of helping survivors and family caregivers maintain a strong relationship after stroke; (2) clear from the perspective of stroke survivors and family caregivers who would be using it; (3) accurate with respect to the advice being offered, and; (4) useful for helping stroke survivors and family caregivers improve the quality of their relationship.Conclusions: This study extends the limited body of research about dyadic interventions after stroke. The next steps in this line of research include feasibility testing the intervention and evaluating its efficacy in a larger trial.

Dyadic approach to post-stroke hospitalizations: role of caregiver and patient characteristics

Aim

To study the association of caregiver factors and stroke patient factors with rehospitalizations over the first 3 months and subsequent 3–12 months post-stroke in Singapore.

Methods

Patients with stroke and their caregivers were recruited in the Singapore Stroke Study, a prospective yearlong cohort. While caregiver and patient variables were taken from this study, hospitalization data were extracted from the national claims database. We used Poisson modelling to perform bivariate and multivariable analysis with counts of hospitalization as the outcome.

Results

Two hundred and fifty-six patient with stroke and caregiver dyads (N = 512) were analysed, with patients having spouse (60%), child (29%), sibling (4%) and other (7%) as their caregivers. Among all participants, 89% of index strokes were ischemic, 57% were mild in severity and more than half (59%) of the patients had moderate or severe disability post-stroke as measured on the Modified Rankin Scale. Having social support in the form of a foreign domestic worker for general help of caregiver reduced the hospitalization rate over 3 months post-stroke by 66% (IRR: 0.342; 95% CI: 0.180, 0.651). Compared to having a spousal caregiver, those with a child caregiver had an almost three times greater rate of hospitalizations over 3–12 months post-stroke (IRR: 2.896; 95% CI: 1.399, 5.992). Higher reported caregiving burden at the 3-month point was associated with the higher subsequent rate of hospitalization.

Conclusion

Recommendations include the adoption of a dyadic or holistic approach to post-stroke care provision by healthcare practitioners, giving due importance to both patients with stroke and their caregivers, integrating caregivers in the healthcare system to extend the care continuum to include informal care in the community and provision of timely support for caregivers.

Development of a novel positive psychology-based intervention for couples post-stroke

OBJECTIVE

Stroke provides challenges for survivors and partner caregivers. Stroke survivors and caregivers are interconnected in their emotional health, including depression, a common stroke sequelae. The purpose of this study was to develop and test the feasibility of a dyadic positive psychology-based intervention (PPI) for couples coping poststroke.

DESIGN

Community-dwelling couples consisted of 1 partner who had a stroke ≥6 months ago and a cohabiting partner caregiver. One or both partner(s) had to report depressive symptoms. The PPI consisted of 1 brief face-to-face training session and an 8-week self-administered intervention in which participants were instructed to engage in at least 2 activities alone and 2 together each week. Two dyads were randomly assigned to a waitlist control to test feasibility of this process. Baseline, postintervention, and 3-month follow-up assessments and post-program feedback were obtained. Descriptive statistics were used to analyze sample characteristics, recruitment and retention rates, adherence, key pre- and postintervention outcomes, and satisfaction with the intervention.

RESULTS

Eleven of 20 couples responding to recruitment letters were enrolled in the study. Ten of 11 dyads completed the program. All participants engaged in activities for at least 6 of 8 weeks. Feedback data indicated participant satisfaction with the intervention, and key outcome measures demonstrated adequate variability.

CONCLUSIONS

The self-administered dyadic PPI is feasible for implementation with couples poststroke. The PPI represents a first step in a novel dyadic approach in this population. Recruitment, enrollment and attrition rates, and feedback will be used to inform a larger randomized trial. (PsycINFO Database Record

Association between incongruence about survivor function and outcomes among stroke survivors and family caregivers

BACKGROUND

Stroke survivors and family caregivers often have incongruent appraisals of survivor cognitive, physical, and psychosocial function. Partner incongruence contributes to poor outcomes for survivors and caregivers.

OBJECTIVES

This study explored whether partner incongruence: (1) differs by function domain; (2) increases or decreases over time, and; (3) is associated with self-rated health, distress, stress, and depressive symptoms.

METHODS

Structured surveys were administered to 32 survivors and caregivers at approximately 3 (enrollment) and 7 months (follow-up) post-stroke. Paired t-tests were used to examine partners' ratings of survivor function at enrollment and follow-up, and changes in incongruence over time. Partial correlations were used to examine the association between incongruence at enrollment and outcomes at follow-up.

RESULTS

Survivors consistently rated their own memory and thinking as significantly better than caregivers rated their memory and thinking. At follow-up, survivors rated their own communication as significantly better than caregivers rated their communication. Incongruence about survivor memory and thinking was associated with survivor distress, as well as caregiver distress, stress, and depressive symptoms. Incongruence about survivor ADLs was associated with caregiver stress and depressive symptoms. Incongruence about survivor social participation was associated with caregiver distress.

CONCLUSIONS

Findings from this study suggest that survivors and caregivers often have incongruent appraisals of survivor function, that incongruence does not improve naturally over time, and that incongruence may be detrimental for survivor and caregiver outcomes. Further research should be directed at the mitigation of incongruence and strategies to improve outcomes for both survivors and family caregivers.

Best Practices for The Interdisciplinary Rehabilitation Team: A Review of Mental Health Issues in Mild Stroke Survivors

Individuals with mild strokes are generally considered fully functional and do not traditionally receive rehabilitation services. Because patients with mild stroke are assumed to have a good recovery, they may have deficits in other areas, including mental health, that are not addressed. As a result, patients with mild stroke are unable to meet quality of life standards. In addition, healthcare professionals are likely unaware of the potential mental health issues that may arise in mild stroke. To address this gap in knowledge, we review the evidence supporting mental health evaluation and intervention in mild stroke. Specifically, we review comorbid diagnoses including depression, anxiety, fatigue, and sleep disturbances and their potential effects on health and function. Finally, we conclude with general recommendations describing best practice derived from current evidence.

Acceptability of mindfulness from the perspective of stroke survivors and caregivers: a qualitative study

Background

Depression is very common among stroke survivors with estimated prevalence rates of approximately 33% among stroke survivors, but treatment options are limited. Mindfulness-Based Stress Reduction (MBSR) is an effective treatment for depression generally, but benefits in stroke patients are unclear. The aim of this study was to determine the feasibility of delivering MBSR to stroke survivors and their caregivers in the community. We conducted a study to gain views of MBSR as a potential treatment option among stroke survivors and their caregivers in the community.

Methods

Participants were recruited from an urban community in Scotland (UK) using newspaper adverts, social media and support groups run by health charities. A 2-h MBSR taster session was delivered by two experienced mindfulness instructors, followed by focus group sessions with all participants on their user experience and suggestions for MBSR modifications for stroke survivors. The focus group sessions were audio recorded and transcribed verbatim. Transcript data were analysed thematically using the framework approach.

Results

The study sample consisted of 28 participants (16 females); there were 21 stroke survivors (11 females) and 7 caregivers (5 females). The median age for participants was 60 years.Most participants described the MBSR taster session as a positive experience. The main challenge reported was trying to maintain focus and concentration throughout the MBSR session. Some participants expressed reservations about the duration of standard mindfulness course sessions, suggesting a preference for shorter sessions. The potential for achieving better control over negative thoughts and emotions was viewed as a potential facilitator for future MBSR participation. Participants suggested having an orientation session prior to starting an 8-week course as a means of developing familiarity with the MBSR instructor and other participants.

Conclusion

It was feasible to recruit 21 stroke survivors and 7 caregivers for MBSR taster sessions in the community. A shorter MBSR session and an orientation session prior to the full course are suggestions for potential MBSR modifications for stroke survivors, which needs further research and evaluation.

Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy: Longitudinal Outcomes for Patients and Family Caregivers

BACKGROUND

Patients who receive ventricular assist device (VAD) therapy typically rely on informal caregivers (family members or friends) to assist them in managing their device.

OBJECTIVE

The purpose of this study is to characterize changes in person-oriented outcomes (quality of life [QOL], depression, and anxiety) for VAD patients and their caregivers together from pre-implantation to 3 months post-implantation.

METHODS

This was a formal interim analysis from an ongoing prospective study of VAD patients and caregivers (n = 41 dyads). Data on person-oriented outcomes (QOL: EuroQol 5 Dimensions Visual Analog Scale; depression: Patient Health Questionnaire-8; anxiety: Brief Symptom Inventory) were collected at 3 time points (just prior to implantation and at 1 and 3 months post-implantation). Trajectories of change for patients and caregivers on each measure were estimated using latent growth modeling with parallel processes.

RESULTS

Patients' QOL improved significantly over time, whereas caregiver QOL worsened. Depression and anxiety also improved significantly among patients but did not change among caregivers. There was substantial variability in change on all outcomes for both patients and their caregivers.

CONCLUSIONS

This is the first quantitative study of VAD patient-caregiver dyads in modern devices that describes change in person-oriented outcomes from pre-implantation to post-implantation. This work supports the need for future studies that account for the inherent relationships between patient and caregiver outcomes and examine variability in patient and caregiver responses to VAD therapy.

Depression, anxiety and quality of life in stroke survivors and their family caregivers: A pilot study using an actor/partner interdependence model

Background

Depression and anxiety are common in stroke survivors as well as their family caregivers. However, it is not known whether each person’s emotional distress contributes to their partner’s quality of life (QOL).

Objective

This study aimed to examine the effect of depression and anxiety on QOL in stroke survivor-caregiver dyads using dyadic analysis technique - the Actor-Partner Interdependence Model (APIM).

Methods

This was a cross-sectional pilot study with a total of 30 participating dyads (30 stroke survivors and 30 family caregivers) from Hospital Rehabilitasi Cheras, Kuala Lumpur, Malaysia. This pilot study was conducted over a period of 3 months, between December 2014 and February 2015. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). QOL was assessed using the Short Form-12 Health Survey (SF-12). All analyses were carried out using IBM SPSS version 22. Dyadic data were analysed using multilevel modelling (MLM).

Results

Depression was uniquely associated with an individual’s own QOL. Survivors and caregivers with higher depression had poorer physical component summary (PCS) scores and mental component summary (MCS) scores. Stroke survivor’s depression exerted a significant actor effect on their PCS (b=−1.42, p=0.001) and MCS (b=−1.52, p<0.001). Caregiver’s depression exerted a significant actor effect on their PCS (b=−2.53, p<0.001) and MCS (b=−1.51, p=0.004). Caregivers’ anxiety negatively influenced their own MCS (b=−0.58, p=0.031). Furthermore, depression exerted a significant partner effect on PCS in stroke survivors (b=−1.19, p=0.003). Caregivers’ depression was also related to their stroke survivors’ poorer QOL, particularly PCS.

Conclusion

The findings suggest that depression affects the QOL of both stroke survivors and caregivers, not only emotionally but also physically. This dyadic study also has evidence pointing to depression in caregivers and its association with stroke survivors’ physical QOL.

Staying married after stroke: a constructivist grounded theory qualitative study

BACKGROUND

Marriages are one of the most powerful predictors of health and longevity, yet research in stroke has focused separately on survivors' experience of impairments and how spouses deal with caregiving.

OBJECTIVES

The purpose of this constructivist grounded theory study was to understand the key themes related to reconstruction or breakdown of marriages after stroke.

METHODS

In semi-structured interviews, 18 couples in long-term marriages discussed how their marriages were reconstructed or broke down after one member of the couple returned home after being hospitalized for a stroke. Constant comparison methods were used to compare the experiences of 12 couples in which both partners indicated their relationship was going well with 6 couples who either separated or remained in parallel marriages.

RESULTS

Analysis revealed an overarching process of reconstructing compatible role-identities and three themes related to the reconstruction or breakdown of the marital identity: feeling overwhelmed, resolving conflict, and perceiving value in the marriage.

CONCLUSIONS

Our findings highlight that marriages are contexts in which survivors and spouses can recalibrate their role-identities. Marriage relationships are not peripheral to survivors' and spouses' outcomes after stroke; rather, marriage is fundamental to the management of impairments and to the well-being of the couple.

Reconciling Marriage and Care after Stroke

La plupart des recherches concernant les impacts des accidents vasculaires cérébraux (AVC) sur les couples ont été centrées sur la transition vers le rôle de soignant ou de bénéficiaire de soins. Même s’il est bien établi que la source principale du soutien dans les cas de maladies chroniques soit le mariage, il n’existe que peu de données sur les effets de ces soins, après un AVC, sur la relation maritale. Afin de combler cette lacune, nous avons réalisé une étude qualitative fondée sur une théorie à base empirique impliquant 18 couples dans lesquels l’un des époux avait subi un AVC. Les résultats ont mis en évidence deux thèmes étroitement liés en ce qui concerne la dynamique de couple : organiser les soins, un thème qui implique la découverte des problèmes dans la vie de tous les jours et leur prise en charge ; et repenser le mariage, un aspect qui nécessite la détermination du sens rattaché à la relation de couple dans un nouveau contexte caractérisé par des soins et des incapacités. Trois types du mariage se sont ressortis à partir de ces processus : la « reconfirmation » du mariage tel qu’il existait avant l’AVC ; la recalibration » du mariage autour des nouveaux soins ; et la « relation parallèle » — considérée comme « son mariage » à chacun des deux prtenaires. Ces résultats mettent en évidence la nécessité de considérer les dynamiques des relations, en plus des connaissances associées à l’AVC et aux soins.

Marriage after the transition to stroke: a systematic review

In health and chronic illness, satisfying marriages promote wellbeing and life satisfaction, yet stroke research has focused on either the stroke survivor as the patient or the spouse as a care-giver. Using Pope, Mays and Popay's framework for synthesising qualitative and quantitative methods, we conducted a systematic review and synthesis of 39 peer-reviewed studies to determine what happens to marital relationships after one partner has suffered a stroke. All the articles examined the impact of stroke. Three overarching themes characterise the evolution of marriage after stroke: chaos in the marriage, work to re-establish the marriage and evolution of the marriages. While both the stroke condition itself and the survivors’ need for care undermined the emotional qualities of the relationship for some couples, about two-thirds were able to retain or regain the relationship closeness. As in other chronic illnesses, the relationship closeness and a couple's ability to collaborate contributed to the survivor's recovery and to the satisfaction with life of the stroke survivor and the spouse. Our results underscore the need to consider the quality of, and the qualities of, the relationship between stroke survivors and their spouses. Future research could include a greater focus on qualitative or mixed-methods approaches to explore the interactions between stroke survivors and spouses that impact the wellbeing of both partners.

Effects of Self-esteem, Optimism, and Perceived Control on Depressive Symptoms in Stroke Survivor-Spouse Dyads

BACKGROUND

Depressive symptoms are common in stroke survivors and their family caregivers. Given the interdependent relationship between the members of dyads in poststroke management, improving depressive symptoms in dyads may depend on their partner's characteristics. Self-esteem, optimism, and perceived control, all known to be associated with depressive symptoms in an individual, may also contribute to their partner's depressive symptoms.

PURPOSE

The purpose of this study is to examine actor and partner effects of self-esteem, optimism, and perceived control on depression in stroke survivors and their spousal caregivers.

METHODS

A total of 112 ischemic stroke survivors (78% white, 34% women; mean age, 62.5 ± 12.3 years) and their spouses (mean age, 60.6 ± 12.9 years) completed surveys in which depressive symptoms, self-esteem, optimism, and perceived control were assessed using the Patient Health Questionnaire, the Rosenberg Self-esteem Scale, the Revised Life Orientation Test, and the Sense of Control Scale. Multilevel modeling, actor-partner interdependence model regression was used to determine influences on depressive symptoms within the dyad.

RESULTS

Individuals with lower self-esteem, optimism, and perceived control had higher levels of depressive symptoms. Stroke survivors whose spouses had lower levels of self-esteem (B = -0.338, P < .001) and optimism (B = -0.361, P < .027) tended to have higher levels of depressive symptoms. Spouses whose stroke survivors had lower levels of self-esteem (B = -0.047, P = .036) also had higher levels of depressive symptoms.

CONCLUSION

We found significant partner effects of self-esteem on depression for both members and partner effect of optimism on patient's depressive symptoms. These findings suggest that further research is needed to determine if dyadic interventions may help to improve self-esteem, optimism, and depressive symptoms in both patients and their caregivers.

The Association of Sleep Disturbances With Quality of Life in Heart Failure Patient–Caregiver Dyads

Sleep disturbance is common in patients with heart failure and their family caregivers. The purpose of this study was to determine whether sleep disturbances of patients and their spousal caregivers predicted their own and their partners’ quality of life (QoL) in 78 heart failure patient–spousal caregiver dyads. Sleep disturbance was assessed using a composite score of four common sleep complaints. QoL was assessed by the physical and mental well-being subscales of the Short-Form 12 Health Survey. The multilevel dyadic actor–partner interdependence model analysis was used to determine the association between sleep disturbance and QoL. Each individual’s sleep disturbance predicted their own poor physical and mental well-being while spousal caregivers’ sleep disturbance predicted their partners’ mental well-being. Results indicated that patients’ mental well-being is sensitive to their spouses’ sleep disturbance. Interventions targeting improving sleep and QoL may have to include both patients and spousal caregivers.

Caregiver burden and emotional problems in partners of stroke patients at two months and one year post-stroke: Determinants and prediction

OBJECTIVES

(a) To determine levels of and factors explaining partners' burden, anxiety and depressive symptoms at two months post-stroke, (b) to predict partners' burden, anxiety and depressive symptoms at one year post-stroke based on patient and partner characteristics available at two months post-stroke.

METHODS

Prospective cohort study. Partners of stroke patients (N=183) were included. Main outcome measures were the Caregiver Strain Index and the Hospital Anxiety and Depression Scale.

RESULTS

Many partners experienced high burden, anxiety and depressive symptoms. At two months post-stroke, these outcomes were associated with the partner variables: age, relationship satisfaction, pro-active coping, self-efficacy, everyday social support, burden, anxiety and depressive symptoms; and the patient variables: stroke severity and depressive symptoms. Partner outcomes at one year post-stroke were mainly predicted by the level of these outcomes at two months post-stroke.

CONCLUSIONS

Partner outcomes at two months post-stroke predict to a large degree partner outcomes at one year post-stroke.

PRACTICE IMPLICATIONS

Measuring partners' burden and anxiety and depressive symptoms in the post-acute phase is recommended to trace partners at risk of long-term burden and emotional problems.

Short-Term Trajectories of Depressive Symptoms in Stroke Survivors and Their Family Caregivers

GOAL

We utilize group-based trajectory modeling (GBTM) to delineate depressive symptom trajectories among stroke survivor-caregiver dyads, to identify predictors of the delineated trajectories, and to assess the influence of time-varying covariates (stroke survivor depressive symptoms and functional disability, caregiver depressive symptoms, and foreign domestic worker [FDW] assistance) on the level of the depressive symptom trajectories.

METHODS

Data on 172 stroke survivor-caregiver dyads in Singapore, for whom depressive symptoms were assessed thrice (baseline/3 months/6 months), were utilized. GBTM was applied to delineate depressive symptom trajectories, and to identify their predictors and time-varying covariates.

FINDINGS

Three stroke survivor depressive symptom trajectories (low and decreasing [47.6%], low and increasing [43.1%], and high and increasing [9.3%]) and 2 caregiver depressive symptom trajectories (low and stable [71.5%] and high and decreasing [28.5%]) were delineated. Caregivers with chronic diseases were more likely (odds ratio [95% confidence interval]: 8.09[2.04-32.07]) and those caring for older stroke survivors (0.94[0.90-0.98]) were less likely to follow the high and decreasing than the low and stable depressive symptom trajectory. An increase in stroke survivor functional disability and caregiver depressive symptoms led to a rise (~worsening) in stroke survivor depressive symptom trajectories. Whereas an increase in stroke survivor depressive symptoms led to a rise in caregiver depressive symptom trajectories, FDW assistance led to a decline (~improvement).

CONCLUSION

Care professionals should be mindful of heterogeneity in depressive symptom patterns over time among stroke survivor-caregiver dyads. Reciprocal association of depressive symptoms in the stroke survivor-caregiver dyad suggests that addressing mood problems in 1 member may benefit the other member, and calls for dyadic mental health interventions.

Incongruence between stroke survivor and spouse perceptions of survivor functioning and effects on spouse mental health: a mixed-methods pilot study

OBJECTIVES

This pilot study investigated stroke survivors' and caregiving spouses' individual perspectives on survivor cognitive and physical functioning and the extent to which incongruence between partners' perceptions affects spouse depressive symptoms and overall mental health.

METHOD

Mixed-methods, with quantitative survey data from 35 couples and qualitative interview data from a subsample of 13 couples being collected and analyzed using paired t-tests, multiple regression with survivor-spouse discrepancy scores as predictors of spouse depressive symptoms, and interpretive-description techniques.

RESULTS

Quantitative data indicated that spouses rated survivor cognitive functioning as significantly worse than survivors rated their own and that survivor-spouse discrepancy scores for physical functioning were significantly associated with spouse depressive symptoms. Qualitative data enhanced understanding about the nuances of partner incongruence and the ramifications of partner incongruence for spouse mental health.

CONCLUSION

Partner incongruence has an impact on spouse depressive symptoms and overall mental health. Interventions targeted at survivor-spouse dyads and focused on improving communication between partners about survivor abilities may be effective for improving the mental health of spousal caregivers.